2004年度中央转移支付项目饮水型地方性砷中毒调查报告

目的查清我国饮水型地方性砷中毒（简称地砷病）病区和高砷区的分布，为科研防治工作提供科学依据。方法 根据《2004年度中央补助地方公共卫生专项资金地方病防治项目技术方案》的要求，开展饮水型高砷水源筛查、部分地区地砷病病情普查以及改水降砷工程调查。水样采用银盐法或原子荧光分光光度计测定居民饮水含砷量。结果高砷水源筛查覆盖面为12个省（区）186个县中的4677个自然村，筛查水样48689份，超标水样1336份，超标村342个；病情调查了4个省29个县中的282个自然村，调查村人口数66312人，查出砷中毒病人3805人，其中皮肤癌病人61人，砷中毒总患病率为5．74％；改水降砷工程调查8个省41个县中的1250个改水工程，正常运转的有1040个，占83．20％；报废工程97个，占7．76％；水砷达标工程925个，占74．00％。结论西部地区高砷井分布范围较广，病情重，改水工程达标率不高，报废较严重，应加强防治工作的管理。     

2002-2004年吉林省高砷水源筛查结果分析

目的了解吉林省砷中毒病区范围及饮水高砷的分布规律．方法采取普查和抽样调查相结合的方法，半定量检测饮水含砷量，对超标（≥0．05mg／L）水样用二乙氨基二硫代甲酸银比色法进行复检。结果对9个县（市、区）的2063个自然村进行了筛查工作．其检测水样40536份，检出超标水样2598份，超标率为6．41％，其筛查出有超标水源的县（市）6个．占所筛查县的66．67％：高砷自然村283个，占所筛查自然村的13．72％：高砷暴露人口近13万人，其中儿童近3万人结论．吉林省西部平原地区高砷水源分布较广，且部分地区已有砷中毒的病情流行．需尽早开展全面的高砷水源筛查及病情普查工作，以便进行防治。     

2005年陕西省饮用高砷水筛查和砷中毒病情调查

目的筛查陕西省饮用水含砷量,调查砷中毒病情。方法在存在高砷水成因的村,按东、西、南、北、中5个方位,采集20份水源水,水砷采用二乙基二硫代氨基甲酸银分光光度法或砷化氢发生原子荧光光谱法测定：在水砷超过0.05mg／L的村,进行砷中毒流行病学调查。对人群中砷中毒病人的调查,按国家地方性砷中毒诊断标准进行诊断。结果在1893份水源水中,有12份含砷量超过0,05mg／L,分布于商洛市所属3个村,暴露人口3148人。饮用高砷水人群砷中毒的临床检出率为37．0％。结论矿物冶炼和开采引起水砷污染,导致砷中毒在陕西省商洛市流行。     

甘肃省高砷水源分布调查

目的掌握甘肃省饮水高砷区分布范嗣和地方性砷中毒流行状况，为今后的防治工作提供依据。方法按全国饮用水高砷水源筛查方案，对13个重点县（市）进行饮用水源含砷量筛查，对11个饮水型氟中毒病区（县）饮水砷进行随机抽查。用二乙氨基二硫代甲酸银分光光度法测定水砷。结果共调查24个县（市）256个乡（镇）的869个村，检测水样5956份，检测出高砷水源210处，超标水源分布在6个县（市），除1个县高砷水源为井水外，其余5个县（市）均为泉水。其中4个县（市）查出砷中毒可疑病例133例，以身体非暴露部位的皮肤色素沉着、脱失为主要体征。其余2个县未发现砷中毒患者。结论甘肃省有高砷水源分布．主要为泉水型高砷区，并在4个县（市）发现有零散病例，但病情较轻。     

2011年山西省地方性砷中毒监测报告

目的掌握山西省饮水型地方性砷中毒病区降砷改水工程运行状况及地方性砷中毒病情，为今后的防治工作提供科学依据。方法按照《2011年度中央补助地方公共卫生专项资金山西省饮水型地方性砷中毒病情调查项目技术方案》的要求，结合既往调查资料，对5个县（市）进行地方性砷中毒监测，调查5个县改水工程运行情况，同时对5个县14个监测村居民的饮水砷含量和暴露人群发病情况进行调查。结果监测改水工程22个，覆盖自然村75个，人口11．5183万人；监测14个村，其中13个是已改水村，水砷含量合格率100．0％，均为小型工程；1个未改水村，监测90户，其中水砷达标28户，合格率31．1％，水砷超标62户，超标率68．9％；在已改水村检查7369人，检出砷中毒患者84例，检出率1．14％，其中轻度病例77例，占1．04％；中度病例7例，占0．09％，无重度病例、新发病例及皮肤癌病例；在未改水村检查240人，检出砷中毒患者18例，检出率7．50％，全部为轻度病例，无中度病例、重度病例及新发病例。结论改水T程运转良好，未改水村水砷超标率高，应尽快采取必要的防治措施，积极寻找低砷水源进行改水。     

2009年山西省地方性砷中毒调查分析

目的了解山西省地方性砷中毒的病情分布,为今后的防治工作提供科学依据。方法 2009年,根据《地方病防治项目技术方案》的要求,结合山西省的实际情况,在已确定的地方性砷中毒病区周围选择10个县的37个村进行水砷含量和病情调查;水砷含量检测采用原子荧光法,砷中毒病情诊断按《地方性砷中毒诊断标准》（WS/T 211-2001）进行诊断。结果 37个村中,未改水村12个、已改水村25个,未改水村水砷超标现象比较严重,最高的达到了0.498 0 mg/L,已改水村中,水砷含量最高的为0.043 2 mg/L,最低的为0.000 1 mg/L,符合国家饮用水水砷卫生标准（〈0.05 mg/L）;未改水村共调查了13 332人,查出砷中毒患者155人,患病率1.16%（155/13 332）,其中轻度患者104人,占0.78%（104/13 332）,中度患者51人,占0.38%（51/13 332）,无重度患者;根据病区判定标准,这12个村均为新发现的砷中毒病区。已改水村共调查19 603人,查出砷中毒患者260人,患病率1.33%（260/19 603）,其中轻度患者223人,占1.14%（223/19 603）,中度患者36人,占0.18%（36/19 603）,重度患者1人,占0.005%（1/19 603）。本次调查的37个村病情较轻。结论在地方性砷中毒病区周围仍然有新病区出现,今后应注重在病区邻近地区进行水砷和病情的调查工作,进一步摸清山西省的地方性砷中毒分布状况。     

2005年全国地方性砷中毒重点监测报告

目的掌握2005年全国地方性砷中毒（简称地砷病）病情及防治措施落实进度．为全国地砷病防治提供依据。方法按《全国地方性砷中毒监测方案》规定方法进行。结果①饮水型病区总改水率为36．23％（96／265），最低为0，最高为100％，改水工程水含砷量合格率为72．44％（113／156）；燃煤污染型病区总改炉率为73．69％（7424／9719），总改灶率为63．71％（2582／4053），铁炉总合格率为66．58％（245／368），烧煤台灶总合格率为73．75％（118／160）。（2）13个落实改水措施的监测点中有4个监测点改水工程水含砷量〉0．05mg／L：燃煤污染型病区3个监测点，改炉改灶并正常使用的居民户和改炉改灶但不正常使用的居民户辣椒含砷量中位数，均有2个监测点超过国家标准，兴仁县监测点单份样品最高超标近72倍。有1个监测点的改炉改灶但不正常使用的居民户玉米含砷量中位数超过国家标准。③饮水型地砷病病区14个监测点中患病率〉30％的有1个，在10％一30％的有5个，〈10％的有8个；燃煤污染型病区3个监测点患病率在20％～25％。结论①饮水型病区改水率很不平衡，改水后水含砷量依然超标的工程达25％以上；②燃煤污染型病区粮食砷污染以辣椒为重；③饮水型病区以轻病区为主，燃煤污染型病区病情重于饮水型病区。     

甘肃省合作市地方性砷中毒流行病学调查

目的了解甘肃省合作市饮水高砷水源的分布和地方性砷中毒（地砷病）的流行情况，为进一步开展防治工作提供科学依据。方法对全市不同类型的饮水水源进行采样检测，同时进行地方性砷中毒病情调查。结果合作市的砷超标水样分布在4个乡19个自然村，呈点状分布，覆盖范围约700km^2，受威胁人群约1万人。在调查的987人中，检出地砷病可疑病例61例．检出率6．18％；高砷水源区人群尿砷平均值为0．0834mg／L，低砷水源区人群尿砷均值为0．0396mg／L，二者间差异有统计学意义（P〈0．05）。结论甘肃省合作市部分地区饮水含砷量超标．并存在地方性砷中毒的流行。     

云南省弥渡县饮水型地方性砷中毒病情调查

目的调查云南省水源性高砷重点地区地方性砷中毒病情,为今后的防治工作提供科学依据。方法采集云南省弥渡县2个高砷重点村和1个对照村所有水源,检测水砷含量;对高砷村和对照村村民临床体检,检测疑似砷中毒患者和对照村村民尿砷含量;根据高砷水源饮用史、临床体检结果和尿砷水平确诊砷中毒病例,并按《地方性砷中毒病区判定和划分标准》判定病区。结果检测2个高砷村水源107个,两村共用的温泉水源和13口自家水井砷含量超标(0.05 mg/L);温泉水源砷含量均值高达0.519 mg/L,是两村最主要的高砷水源,覆盖人口2 000余人;检测对照村水源20个,砷含量均合格;临床筛检两高砷村村民404人、对照村38人,高砷村检出疑似病例61例;检测高砷村人群尿样115份,高芹村尿砷中位数0.24 mg/L,高孟营村尿砷中位数0.07 mg/L;检测对照村村民尿样38份,尿砷中位数0.02 mg/L;确诊地方性砷中毒病例32例,砷中毒可疑病例5例,总检出率9.16%。结论云南省弥渡县两高砷村均被确认为饮水型地方性砷中毒轻病区,是云南省首次确认的地方性砷中毒病区。     

2006年甘肃省地方性砷中毒调查结果分析

目的 了解2006年甘肃省饮水高砷区分布范围和地方性砷中毒流行状况,为今后的防治工作提供依据.方法 按全国饮用水高砷水源筛查方案,选择甘肃省12个县(区)进行饮用水含砷量筛查,用二乙氨基二硫代甲酸银分光光度法测定水砷,皮肤病变按<地方性砷中毒诊断标准)(WS/T 211-2001)进行诊断.结果 12个筛查县共调查145个乡540个村,采集水样11 360份.检测出>0.05 mg/L的高砷水源22处,占筛查水源数的0.19%(12/11 360),其中夏河县洒索玛村1眼冷泉水水砷最高,为0.97 mg/L.对筛查出的17个高砷村进行了砷中毒病情调查,夏河县的4个村有病人检出,其中王格塘汪塘、完肯、完安昂村检出率均<10%.水砷最高的洒索玛村病情较重,检出率为49.68%(77/155),检出鲍文氏病变者1例,年龄范围为2～82岁.该村汉、回、藏3个民族混居,以汉族检出率最高为81.25%(13/16),回族次之为50.56%(45/89),藏族最低为38.00%(19/50).其余13个村未检出阳性体征者.结论 甘肃省高砷水源分布范围进一步扩大,局部病区病情较重,并存在冷泉型地方型砷中毒病区.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.